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Underweight and Underrepresented: The Cardiac Complications of Disordered Eating

We get it. Being overweight is bad for you. Extra weight strains the heart, forcing it to work harder, consequently raising your blood pressure and increasing your risk of myocardial infarction, cardiomyopathies, and stroke. Spending your days on the couch binge-watching Grey’s Anatomy probably isn’t the best lifestyle choice, and a diet of salty, trans-fat-fried carbohydrates cannot possibly be good for you. You do need some exercise to strengthen your heart, and fruits and vegetables are a nutritional necessity, but that’s common knowledge; we all know that already. So, let’s discuss something different; let’s discuss the other extreme–severe emaciation, caloric restriction, and compulsive purging. Underweights are underrepresented by/in the cardiovascular health community, and thusly, I have taken it upon myself to educate you on this equally unhealthy lifestyle.

Bradycardia and hypotension are the two most common cardiac complications of anorexia. In an endeavor to conserve energy, the body begins to shut down, slowing the heart rate and consequently lowering the blood pressure; neither matter is helped by nutritional irregularities/deficiencies (such as B-12, iron, magnesium). Both bradycardia and hypotension are generally benign, but prolonged cases of each can result in confusion, dizziness, fainting, fatigue, heart failure, and tissue death. Many bradycardic and hypotensive patients notice spikes in their heart rate and blood pressure when they stand up; some even experience palpitations, lightheadedness, and collapse. And that’s just standing–imagine what exercise can do!

Exercise in and of itself cannot cause a heart attack, but it can trigger one. The stress on your heart can induce palpitations, arrhythmias, arterial spasms, sudden cardiac death, and, yes, a heart attack. This exercise, while it should strengthen your heart, ends up weakening it because of the atrophic nature of muscles during starvation; you break down the muscle without giving it the energy it needs to build up again. Do I really need to tell you how dangerous this is?

This brings me to the second half of my post, the nutritional component. When deprived of nutrients, the body starts to eat itself. Contrary to popular belief (read: diet industry propaganda), fat is not the first thing to go; on account of their nutritional density, muscles are devoured, and the heart, as one of the largest muscles, is a natural victim. You can literally eat your heart out.

This catastrophic self-consumption leads to many dire results, including mitral valve prolapse, the flopping of the mitral valve, where its flaps collapse and allow for valvular leakage and regurgitation, eventually leading to arrhythmias, left ventricular enlargement, strokes, and heart attacks. Self-consumption is premised by malnutrition, an incredibly harmful state in its own right. A caloric deficit is also a nutritional deficit, since calories are not just energy, but couriers, carrying vital vitamins and minerals, including essential electrolytes. Electrolytes are necessary for heart function, as the heart’s de- and repolarisation is facilitated by ionic channels. A severe shortage of electrolytes can have immediate results like life-threatening cardiac arrhythmias; these, including the frequently fatal ventricular fibrillation, can cause cardiac arrest and, in rare instances (represent!), a heart attack. Consequences can be lasting as well, with electrolyte deficiencies yielding permanent extrasystoles (both atrial and ventricular, including various varieties of geminy) and Long QT Syndrome, the latter of which predisposes one to chaotic heartbeats, and in turn, heart attacks and/or cardiac arrests. It is also worth noting that heart attacks do permanent damage to the myocardial muscle, creating eventual and incurable cardiomyopathies.

Additionally, many underweight individuals are susceptible to vicious binge/purge cycles. A binge’s rapid influx of calories can cause systemic shock, manifesting as cardiac arrest, and self-induced emesis can do the same, with dehydration and the abrupt loss of electrolytes rendering similar effects. The cardiac complications of anorexia can be fatal, and if you are lucky enough to escape them, you are still susceptible to recovery-occurrent ones such as refeeding syndrome, a type of systemic shock analogous to that of a binge. Sounds fun, right?

Please do not do this to yourself. Maintain a healthy weight, eat a balanced diet, and exercise in moderation! Your body will thank you.

Memorial Day Murph Challenge

Today I completed the Murph Challenge in honor of my cousin Patrick. He wanted to join the Marines but died in a tragic act of gun violence before he could enlist. This workout was for you, Patrick, as well as all of the amazing men and women who have so bravely given their lives for our country. Thank you.

Here is a picture of my hand with my time on it.

An Unhappy Birthday

I’ve never really liked birthdays. In fact, I grew up dreading them. My mother almost always forgot the occasion. Relatives I hated swarmed in from out of town. People watching me eat meant I had to eat more. I felt I didn’t deserve any of the presents I received. The passage of time made me anxious about how little I’d accomplished. I frequently spent the day in a hospital of some sort. And then there was the cake.

The cake! Oh god, the cake! The cake was the worst part. I’d spend all year worrying about the cake, planning for the cake, calculating how many calories were in the cake, devising ways to compensate for the cake. A slice of cake had 1000 calories, right? So, if I ate nothing else that day, I could have half a slice and not gain any weight, right? Or I could eat normally and exercise for five hours to burn it off? Or I could purge it? No, that would only get rid of 30% of the calories, providing I did it properly, and I’d still have 666.66 calories in surplus. What if I restricted for two days before? Could I have a whole slice then? Or could I just have a bite? How many calories were in a bite? Or a tiny bit of the frosting? Just a lick! That was my favourite part anyway. But there would be crumbs on the frosting. How would I account for those calories? It wasn’t worth it. I just wouldn’t have any. But I would exercise extra anyway—just in case, to burn off the cake I didn’t eat.

That was my birthday every year, and it was miserable. Like many people, I used birthdays as an opportunity to beat myself up, to get down on myself for all the things I hadn’t done, for everything that I wasn’t. The event emphasised my biggest insecurities—failure and fatness—and I spent the holiday punishing myself for my ‘obesity’ and ‘idiocy’. Needless to say, it was not much of a celebration.

It was my birthday last week, and although my circumstances were not ideal, I tried to make the best of it. I bought myself a book I wanted. I didn’t receive many other gifts, but I’m glad I have this text for my research. I attended two dance classes. They weren’t the challenging jazz ones back home at Pineapple, but they gave me an opportunity to work on my technique. I redeemed my birthday reward for a free drink at Starbucks. Maybe I ordered my hot chocolate with nonfat milk and scraped the whipped cream off in a panic, but at least I challenged my fear of liquid calories. I spent some quality time with my cat Katherine. It was sad not to be in London, but Katherine is so adorable and sweet. I stopped at my favourite bakery. My cake was delicious even though my friends were not there to share it with me. Did I have the best birthday ever? No, not by any stretch of the imagination, but I know that I’m lucky to be alive having this birthday at all.

Birthdays can be hard, I know. You don’t have to like them, and you don’t have to celebrate them. You can treat them like an ordinary day if you want to! Just please, please don’t use them as excuse to hurt yourself–mentally or physically. Acknowledge who you are and where your at. You may not be who or where you want to be, but you are someone, somewhere. I hope you can appreciate that.

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Disclaimer: This cake was from the Saturday before my birthday. I enjoyed a chocolate cake on the day itself, but the icing smudged on the bus trip back to my flat, and consequently I didn’t get any good pictures.

How to Travel with an Eating Disorder

Travelling with an eating disorder is stressful–whether you’re in relapse or recovery. Your normal foods are not available. You can’t eat at your regular times. You’re not able to exercise like you normally do. It’s hard, I get it. I’ve been there many times, and it was horrible. But you know what? I survived.

My advice is simple. Fuck it. Yes, you read that correctly. Fuck it! Obviously make sure you’re eating enough, but other than that, fuck it. Throw all your food rules out the window, and just eat whatever the fuck you want. Sampling the local cuisine is part of experiencing a culture, so try anything and everything. Does your destination have a signature dish? Get it from several places and see how it differs regionally. Are you going to the beach? Lick an ice cream cone as you lay in the sun. Have you heard about any cool restaurants in the area? See if they live up to the hype. Do you walk by a bakery as you leave your hotel? Buy a pastry to snack on while you explore. Is there a coffee shop near a landmark you’re going to? Sit there with some tea and watch people walk by.

Will you gain weight on this trip? Maybe. Will you lose a couple pounds? Possibly. Will your weight stay exactly the same? Perhaps. Who knows, and honestly, who cares? Travel is a opportunity and a privilege. Don’t waste your time and money working out in hotel rooms and scouring the city for the lowest calorie salad. Go experience the place you’re in. Talk to the locals, visit the museums, shop on the high streets, and most importantly, eat the food. Enjoy your vacation! The memories you make matter so much more than the number on the scale.

The Will to Survive

I believe in life after death—just not in the religious way. I don’t believe in God or Heaven, in reincarnation or ghosts. No, I believe in something very different. I believe in recovery, hope, and second chances, in the future and the promise of a better life. I believe in miracles, magic, and medicine. I believe in literature, cake, and fairy dust. Most of all, though, I believe in Shakespeare. Let me explain:

When I was seven, I stole a copy of Hamlet from my second grade teacher’s desk because the cover reminded me of orange sherbet; I took it home and acted it out with pieces of bread. I had no clue what was going on, and I recall having to crack open Polonius (an aptly cast dictionary) every other word. Nonetheless, I found myself enchanted; the words mesmerized me, and I wanted nothing more than to be a part of their world. Thus began my lifelong love affair with Shakespeare.

I devoted the next couple years to reading, seeing, and performing as much of the cannon as possible. I’d devoured the comedies (Romances exempted) by the close of fourth grade, and just prior to sixth I used the prize money from my violin competitions to fly to London to see the Globe replica; the following year I played Hermia in my middle school’s production of A Midsummer Night’s Dream, which led to further performances in school, local, regional, touring, and festival settings. Performing and sharing Shakespeare became my greatest joy, and I vowed to star in the Royal Shakespeare Company someday.

It wasn’t until my senior year of high school, however, that I was introduced to academia. Ms. Kimberly Horne was lecturing on King Lear, and for the first time in my life I found myself challenged in an English class. Disoriented but intrigued, I practically lived in her office for the duration of the unit, interrogating her about everything from fundamental prosody to textual variation to the role of milk in Shakespearean tragedy. A gifted teacher as well as a brilliant scholar, Ms. Horne gave hours to my cause, talking me through passages, answering my questions, and acquainting me with relevant theorists/criticism. She exposed me to a whole new side of Shakespeare, the academic side, and I loved it; inspired and amazed, I decided to pursue criticism professionally.

I spent the following summer at Harvard with Ms. Horne’s favorite Shakespeare scholar, Dr. Marjorie Garber. The latter was leading two graduate seminars, and I, fresh out of high school, had managed to worm my way into both. The experience was truly transformative. Dr. Garber, the absolute apotheosis of intelligence, revolutionized my views on Shakespeare, literature, and the world. Under her tutelage I learned to read critically, think analytically, write professionally, and speak eloquently. I went into her class a Shakespeare aficionado, but I left a Shakespeare scholar.

A month later, I started my undergraduate education at King’s College London, my so-called “dream school”. It was, in short, a nightmare; my courses were elementary, my lecturers lackluster, and my peers imbeciles. Wasn’t this supposed to be a world-class institution? Were these acclaimed academics capable of nothing more than meager plot summary? Where were the Baby Blooms and Little Lessings I was so hoping to meet (and why did none of my aforesaid classmates comprehend that fairly mainstream allusion?!)? Bored and betrayed, I relapsed into my eating disorder. Starvation supplanted studying, seminars were shirked in favor of trips to the gym, and before I knew it, I had swapped out my degree for a bed at the local A and E. My ill-conceived endeavor at amusement had suddenly spiralled into a devastating deringolade, and by the end of term I was a 30 kg cardiac patient with no hope of a meaningful future. I had lost Shakespeare, my Shakespeare, and I just wanted to die.

Anorexia nearly killed me. It stopped my heart, ruined my life, and left me for dead, but somehow, somewhere, I found the will to survive. I had the one thing stronger than anorexia’s desire for thinness, and that was my love for Shakespeare. So armed with my Norton Anthology, I decided to fight; I packed up my critical collection, withdrew from university, and returned to America to get the help I so desperately needed. Two years, four cardiac rehabilitation courses, seven doctors, and nineteen kilograms later, I can now say I have recovered from anorexia. I am currently writing two academic articles, preparing a lecture circuit, and compiling a curriculum for an forthcoming symposium. I will also be returning to university this Fall. I have future, a rather bright one at that!

Anorexia is in my past now. It has to be. There are plays to read and books to write. So thank you to University College London for giving me a second chance, Sugar Mama’s Bakeshop for the most amazing cake, and William Shakespeare for saving my life. This year is going to be LIT(erary).

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Review: Black Velvet Birthday Cake from Sprinkles Cupcakes

I’ve decided to start doing food reviews, and I thought I’d kick things off with an unpopular opinion. I don’t like Sprinkles. Their cakes are bland and dry, their frosting sparse and crusty. The cupcakes come in an odd square shape, which, in addition to being incredibly unattractive, minimises product surface area. You are paying a lot of money for very little dessert. It’s a rip-off! Also, what is the thing on top? Is it a dragée? Is it candy? Is it someone’s lone, pathetic attempt at a sprinkle? I don’t know, but it’s whatever it is, it’s disconcertingly flavourless, bizarrely crunchy, and otherwise inedible. That goes for their merchandise as a whole.

That being said, I found myself in line at a Sprinkles today. I caught a typographical error on their website, and they gave me a coupon for a free cupcake. I am not one to turn down free food, so I took this opportunity to try their new limited edition offering, a black velvet cupcake with chocolate cream cheese frosting and rainbow sprinkles inside. It wasn’t horrible.

The sponge was unpleasantly grainy, but there was much more of a chocolate flavour than I’ve gotten from them in the past; it wasn’t just “brown vanilla”. The frosting was also better than I remembered; it was by no means smooth or creamy, but at least it didn’t flake off like before. I wish the cake were moister and the chocolate flavour stronger, but this would’ve been a fine cupcake—if it weren’t for the nonpareil filling. The sprinkles themselves are the demise of this Sprinkles creation. Obviously, signaturely cheap, they were like eating pebbles, not to mention a potential choking hazard. Nutella, peanut butter, marshmallow cream, or really anything would’ve been preferable. They could’ve left it empty, for all I care; even that would’ve been an improvement.

All in all, I did not like this cupcake, and I (still) do not like Sprinkles. This is a 5/10 offering from a 5/10 place. Go elsewhere to meet your cupcake needs, but if you insist on visiting Sprinkles, opt for red velvet, gingerbread, or salted caramel. They’re less reprehensible.

The Black Velvet cupcake (depicted below/described above) is available through Sunday at all Sprinkles locations. Get yours (or don’t), and let me know what you think. Any questions? Requests for products you want reviewed? Offers of free stuff? General tidings? Comment below.

Recipe: Hot Cross Buns

Easter is fast approaching, and as I can’t subsist entirely on Cadbury Creme Eggs (believe me, I’ve tried), I thought I’d whip up a different holiday treat today. Here’s my take on hot cross buns:

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Ingredients:

For the buns:

  1. 4 1/2 cups all purpose flour, plus extra for lining and kneading
  2. 1 1/4 cup milk
  3. 2 large eggs, plus 1 yolk
  4. 1/2 cup butter, plus extra for greasing
  5. 1/6 cup apple juice
  6. 1/4 cup and 1 tablespoon brown sugar
  7.  1/3 cup raisins
  8. 1/3 cup dried sultanas
  9.  1/3 cup dried currants
  10. 2 1/4 tablespoons (roughly one sachet) self-raising yeast
  11. 1 1/8 teaspoon baking powder
  12. zest of two small oranges
  13. 2 tablespoons vanilla extract
  14. 1/8 teaspoon cloves
  15. 1 1/2 teaspoons salt
  16. 1 teaspoon cinnamon
  17. 1/4 teaspoon nutmeg
  18. 1/8 teaspoon ground cloves
  19. 1/8 teaspoon all spice

For the glaze:

  1. 1 egg white, reserved from above
  2. 1 1/2 tablespoon milk

For the icing:

  1. 1 1/4 cup confectioner’s sugar
  2. 1/8 teaspoon salt
  3. 4 teaspoons milk

Preparation:

  1. Grease a 9 x 13 inch pan with butter. Line with a dusting of flour.
  2. In a small bowl, consolidate the dried fruits and apple juice.  Microwave for 30 seconds, and set aside for later.
  3. In a large bowl, combine the remaining wet ingredients for the buns. Mix thoroughly with a whisk or electric mixer.
  4. In a smaller bowl, combine the dry ingredients for the buns (excluding the fruit, of course, which is stewing in the juice). Add them to the wet ingredients and mix until smooth.
  5. Add in the fruit/juice mixture and beat further.
  6. Spread a light coating of flour on a sufficiently large flat surface. Knead the dough until it is soft and elastic. (This should take 5-6 minutes.)
  7. Divide the dough into ice cream scoop sized pieces, and place them in your pan (or on a baking sheet, in which case you should omit step 1 and cover a large baking sheet with parchment paper instead). Cover and allow the dough to rise at room temperature for an hour.
  8. Preheat the oven to 375 degrees F.
  9. Bake for 15-20 minutes or until golden brown.
  10. In a small bowl, whisk together glaze ingredients. Brush the glaze over the tops of the buns immediately after removing them from the oven.
  11. Allow the buns to cool for at least 10 minutes before beginning to prepare the icing. Meanwhile, you should slice the buns, if fused together, into your desired serving portions; you can keep them in the pan to do this.
  12. For the icing, mix the two ingredients, adding in more milk as needed. Pipe icing in a cross shape on top of each bun.
  13. Serve warm.

Enjoy, and I HOP everyBUNNY has an EGGcellent Easter, filled with chocolate and hot cross PUNS. (Sorry, I had to!).

 

“Am I Dying?” and Other Hunger-Related Questions

Hunger is a tricky thing for people with eating disorders. We’ve disregarded it for so long that we forget what it feels like. I, for one, ignored my hunger until it became a perpetual part of my reality. I started experiencing it again in recovery, and I was honestly so confused; I kept asking my dietician “what’s happening to me? what am I feeling? what is this? am I dying?” Today’s post answers these questions and more. Read on to learn about hunger:

Question: What is hunger?

Answer: Hunger is the physical sensation generated by the body when needs more nutrients. It is caused by hypothalamic processing of the hormone ghrelin (lenomorelin), which is secreted by gastrointestinal tract in response to blow blood glucose levels and/or an empty stomach.

Q: How do you know if you’re hungry?

A: We all know about the obvious stomach growling, but hunger can manifest in many other ways, too. Symptoms include a churning, hollowness, or tightness in the stomach, lightheadedness, dizziness, or fainting, headaches, muscle cramps, shakiness/jitters, rapid heartrate, exhaustion and fatigue, irritability/agitation, lack of concentration, and even nausea.

Q: What should you do if you feel hungry?

A: Generally, if you’re hungry, you should eat. Exceptions include if you are fasting for a surgical procedure, on a meal plan that dictates your intake times, or have been otherwise advised by a medical professional not to do so.

Q: Why are you hungrier on some days than on others?

A: Hormone, activity, and stress levels can all influence your hunger. For instance, women tend to require extra nutrition prior to their menstrual periods (on account of increased calorie expenditure), and cardiovascular exercise has been shown to stimulate appetite. Growing children will also consume more calories than average, and studies have shown that lack of sleep leads to inversely proportional food consumption.

Q: What if your hunger can’t keep up with your metabolism or vice versa?

A: A healthy individual’s hunger and fullness cues will be accordance with their body’s nutritional needs, and they will eat enough to maintain a healthy weight at a reasonable activity level. Of course, this is not the case for all people; a number of factors including metabolic syndromes, chronic dieting, eating disorders, autoimmune diseases, certain medications, and economic factors can disrupt the body’s natural rhythm, resulting in skewed conditions on either side. In such cases, dietetic services are required to prevent and treat the effects of malnutrition.

Q: How does hydration affect your hunger?

A: Apparently, 37% of people confuse thirst with hunger. This is primarily due to the lack of stomach volume presented by each.

Q: How do you know whether you hungry or thirsty and what should you do about it?

A: At times, hunger and thirst present with similar indicators, notably dizziness, fatigue/exhaustion, headache, nausea, muscle cramps, tachyarrhythmias, and stomach churning/emptiness. Thirst is often accompanied by the following differentials–dark urine, dry mouth, and perspiration. If you are thirsty, you should rehydrate with fluids or eat foods with a high water content (like melon). In the past, dieticians have advised patients to drink water fifteen to twenty minutes before a meal to make sure they are actually hungry, but due to frequent disordered manipulation of this guidance, doing so is no longer a common practice; instead, nutritional professionals recommend you hydrate throughout the day and honour your hunger signals.

Q: What is emotional hunger and why wasn’t it mentioned above?

A: Emotional hunger is a psychological craving for a certain food. It was not included in the above designation, as it is a separate biochemical process. Emotional hunger is a psychological phenomenon while physical hunger is physiological.

Q: How can you tell if your hunger is emotional or physical?

A: While both physical and emotional hunger can make you crave certain foods, they are very different in nature. If your body is craving something, it is because it needs a specific nutrient contained therein; any food containing that nutrient will satisfy it, and your craving will subside. In instances of emotional hunger a food is desired on account of its associations; that food and only that food will do. Emotional hunger also tends to be accompanied by a (typically negative) emotion; it comes on suddenly and does not respond to physical hunger/fullness cues (the processing and secretion of the hormones ghrelin and leptin respectively), leading to an over- or under eating of the specified food.

Q: What should you do if you experience emotional hunger?

A: A little emotional eating won’t hurt you. It’s perfectly normal to celebrate your promotion with a slice of cake or to pick up pizza from your favourite restaurant after a bad day. Just don’t make it a habit. Food can facilitate celebration and comfort, but it is not (and never should be) a substitute for actually dealing with your feelings.

Is there anything else YOU want to know about hunger? Drop your questions in the comments below, and I’ll try to get back to you as soon as I can. Have a delicious day, everyone, and Happy Spring! xo